Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure

• Published in: Thorax 2004-12, Vol.59 (12), p.1020-1025
• Main Authors: Chu, C M, Chan, V L, Lin, A W N, Wong, I W Y, Leung, W S, Lai, C K W
• Format: Article
• Language: English
• Subjects: Activities of daily living; Acute Disease; Aged; Biological and medical sciences; Chronic Obstructive Pulmonary Disease; Cohort Studies; COPD; Critical Illness; Dyspnea; Female; Humans; Hypercapnia - mortality; Hypercapnia - therapy; Intubation; Male; Medical sciences; non-invasive ventilation; outcome; Patient Readmission - statistics & numerical data; Patients; Physical therapy; Pneumology; Pneumonia; Prospective Studies; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - therapy; Rehabilitation; Respiration, Artificial - methods; Respiratory failure; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Respiratory system : syndromes and miscellaneous diseases; survival; Survival Analysis; Ventilators
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.2004.024307

Background: Non-invasive ventilation (NIV) has been shown to reduce intubation and in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF). However, little information exists on the outcomes following discharge. A study was undertaken to examine the rates of readmission, recurrent AHRF, and death following discharge and the risk factors associated with them. Methods: A cohort of COPD patients with AHRF who survived after treatment with NIV in a respiratory high dependency unit was prospectively followed from July 2001 to October 2002. The times to readmission, first recurrent AHRF, and death were recorded and analysed against potential risk factors collected during the index admission. Results: One hundred and ten patients (87 men) of mean (SD) age 73.2 (7.6) years survived AHRF after NIV during the study period. One year after discharge 79.9% had been readmitted, 63.3% had another life threatening event, and 49.1% had died. Survivors spent a median of 12% of the subsequent year in hospital. The number of days in hospital in the previous year (p = 0.016) and a low Katz score (p = 0.018) predicted early readmission; home oxygen use (p = 0.002), APACHE II score (p = 0.006), and a lower body mass index (p = 0.041) predicted early recurrent AHRF or death; the MRC dyspnoea score (p